| Clay County Middle School Wellness Center | |
|
236 Church St Clay WV 25043-9412 | |
| (304) 587-4375 | |
| (304) 587-4375 |
| Full Name | Clay County Middle School Wellness Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 236 Church St, Clay, West Virginia |
| Authorized Official Name and Position | Dora L Potasnik (CREDENTIALING) |
| Authorized Official Contact | 3045872541 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clay County Middle School Wellness Center Po Box 147 Clay WV 25043-0147 Ph: (304) 587-7301 | Clay County Middle School Wellness Center 236 Church St Clay WV 25043-9412 Ph: (304) 587-4375 |
| NPI Number | 1093765869 |
|---|---|
| Provider Enumeration Date | 05/11/2006 |
| Last Update Date | 02/06/2013 |
| Medicare PECOS PAC ID | 0446232987 |
|---|---|
| Medicare Enrollment ID | O20120831000422 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093765869 | NPI | - | NPPES |
| 001979216 | Other | WV | MS BCBS |
| 0035189005 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 2267-0579 (West Virginia) | Primary |
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